保留乳头乳晕乳腺癌改良根治术后即刻扩展型背阔肌乳房再造术的临床应用

Efficacy and safety of immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-areolar-sparing mastectomy for breast cancer

目的:探讨保留乳头乳晕乳腺癌改良根治术后即刻扩展型背阔肌乳房再造术的安全性与疗效。方法:回顾性分析蚌埠医学院第一附属医院肿瘤外科32例行保留乳头乳晕乳腺癌改良根治术后即刻扩展型背阔肌乳房再造术患者(观察组)和34例行传统乳腺癌改良根治术患者(对照组)临床资料,比较两组患者并发症、预后,并分析观察组重建乳房外形评分情况。结果:两组年龄、肿瘤大小、病理分期方面无统计学差异(均P>0.05);观察组与对照组术后总并发症发生率差异无统计学意义(37.5%vs.32.4%,P>0.05)。所有患者随访18~60个月,中位时间44个月,观察组局部复发2例,远处复发3例;对照组局部复发3例,远处转移3例,观察组与对照组3年无瘤生存率差异无统计学意义(87.5%vs.91.2%,P>0.05)。观察组乳房外形评分优良率为90.6%。结论:保留乳头乳晕乳腺癌改良根治术后即刻扩展型背阔肌乳房再造术安全有效,重建的乳房外观满意,且不增加并发症与局部复发、远处转移风险。

Objective： To investigate the efficacy and safety of immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-areolar-sparing mastectomy for breast cancer.Methods： The clinical data of 32 patients undergoing immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nipple-areolar-sparing mastectomy（observation group） and 34 patients undergoing conventional modified radical mastectomy（control group） in the Department of Surgical Oncology of the First Affiliated Hospital of Bengbu Medical College were retrospectively analyzed. The complications and outcomes between the two groups were compared and the postoperative breast appearances of the patients in observation group were analyzed.Results： There were no significant differences in age, tumor size and pathological stage between the two groups of patients（all P〉0.05）. The overall incidence of postoperative complications in observation group and control group showed no significant difference（37.5% vs. 32.4%, P〉0.05）. All patients were followed-up for 18 to 60 months with a median period of 44 months. Local recurrence occurred in 2 cases in observation group and 3 cases in control group, and distant metastasis occurred in 3 cases each in observation group and control group. The 3-year disease-free survival rate in observation group and control group showed no significant difference（87.5% vs. 91.2%, P〉0.05）. The excellent and good rate of the postoperative breast appearance was 90.6% in observation group.Conclusion： Immediate breast reconstruction with extended latissimus dorsi myocutaneous flap after nippleareolar-sparing mastectomy is a safe and effective procedure, and it offers satisfactory postoperative breast appearance with no increase of the risks of complications as well as local recurrence and distant metastasis.